Objective To conduct a bibliometric analysis of domestic and international literature on the research of Sijunzi Decoction over the past 20 years,and to explore the research status,hotspots,and development trends of Sijunzi Decoction.Methods This article retrieved journal articles related to the research of Sijunzi Decoction from 2004 to 2024 in the CNKI,Wanfang,VIP,and Web of Science databases.Microsoft Excel was used for publication volume analysis,while CiteSpace software was employed for keyword co-occurrence,clustering,and burst analysis,and then the analysis results were visualized.Results After literature retrieval and screening,3 573 Chinese articles and 113 English articles were included.Over the past two decades,the publication volume showed a trend of steadily increasing.The most frequent keywords in Chinese and English literature on the research of Sijunzi Decoction were spleen deficiency syndrome and gene expression,while the keywords with strongest burst were experimental research and data mining.Conclusion The research of Sijunzi Decoction in the last 20 years was mainly through animal experiments and clinical applications,and the research hotspots focus on the treatment of diseases of spleen deficiency syndrome and on the improvement of immune function of cancer patients.The extraction and identification of active components in Sijunzi Decoction and the study on the therapeutic mechanism in diseases of spleen deficiency syndrome are probably the future research trends.

Objective:To explore the causal association between insulin-like growth factor-1(IGF-1)and colorectal cancer(CRC)based on two sample Mendelian randomization(MR)analysis.Methods:A bidirectional two sample MR analysis was conducted based on publicly aggregated data from the IEU OpenGWAS project.The inverse variance weighted(IVW)method was used as the main analysis model to assess the causal relationship between IGF-1 and CRC.Additional analyses were performed using weighted median(WM),MR-Egger regression,weighted mode estimator(WME),and simple mode(SM)methods.Sensitivity analysis was performed to assess the robustness of the results.Results:A total of 386 single nucleotide polymorphisms(SNPs)were selected as instrumental variables(IVs)with IGF-1 as the exposure factor.The MR analysis results revealed a positive causal association between IGF-1 and the risk of CRC[odds ratio(OR)=1.178,95％confidence interval(CI):1.092-1.272)](P＜0.001),and the association remained significant after adjusting for height[OR(95％CI)=1.214(1.111,1.327)](P＜0.001).Cochran's Q-test showed heterogeneity among the IVs(P＜0.05),while the horizontal pleiotropy of IV was not detected by the MR-Egger regression(P＞0.05).The leave-one-out analysis showed that the MR results were robust.Reverse MR analysis indicated no reverse causal relationship between IGF-1 and CRC[OR(95％CI):1.017(0.997,1.037)](P=0.103).Conclusion:There is a causal relationship between IGF-1 level and CRC,and elevated IGF-1 level could be a risk factor for CRC.

Objective To explore the correlation between central venous oxygen saturation(ScvO2),blood lactate(Lac),arterial oxygen saturation(SaO2)and mechanical ventilation time in infants with congenital heart disease(CHD).Methods Eighty-four CHD children treated in the First People's Hospital of Zunyi were enrolled between January 2020 and December 2024.According to postoperative mechanical ventilation time,they were divided into prolongation group(28 cases,mechanical ventilation time≥72 h)and non-prolongation group(56 cases,mechanical ventilation time<72 h).The clinical data,score of risk adjustment for congenital heart surgery(RACHS-1),levels of ScvO2,and Lac and SaO2 in the two groups were compared.The risk factors of postoperative mechanical ventilation time were analyzed by multivariate logistic regression analysis,and predictive value of ScvO2,Lac and SaO2 for prolonged mechanical ventilation time was analyzed by ROC curves.The clinical outcomes in the two groups were recorded.Results There were significant differences in age,preoperative pneumonia,RACHS-1 grading,and levels of ScvO2,Lac and SaO2 among children with different mechanical ventilation time(P<0.05).Multivariate logistic regression analysis showed that ScvO2,Lac and SaO2 were independent influencing factors of postoperative mechanical ventilation time(P<0.05).ROC curves analysis showed that area under the curve(AUC)values of ScvO2,Lac,SaO2 and combined detection for predicting prolonged postoperative mechanical ventilation were 0.846,0.863,0.839 and 0.917,and the best cut-off values were 67.64％,1.51mmol/L and 96.06％,respec-tively(P<0.05).The failure rate of weaning in the prolongation group was higher,and stay time in PICU and actual length of hospital stay were longer than those in non-prolongation group(P<0.05).Conclusion The levels of ScvO2,Lac and SaO2 are related to mechanical ventilation time in CHD infants.They are all independent risk factors affecting prolonged mechanical ventilation and can be applied as auxiliary detection indexes to predict the prolonga-tion of mechanical ventilation in clinical practice.

Objective To explore the correlation between central venous oxygen saturation(ScvO2),blood lactate(Lac),arterial oxygen saturation(SaO2)and mechanical ventilation time in infants with congenital heart disease(CHD).Methods Eighty-four CHD children treated in the First People's Hospital of Zunyi were enrolled between January 2020 and December 2024.According to postoperative mechanical ventilation time,they were divided into prolongation group(28 cases,mechanical ventilation time≥72 h)and non-prolongation group(56 cases,mechanical ventilation time<72 h).The clinical data,score of risk adjustment for congenital heart surgery(RACHS-1),levels of ScvO2,and Lac and SaO2 in the two groups were compared.The risk factors of postoperative mechanical ventilation time were analyzed by multivariate logistic regression analysis,and predictive value of ScvO2,Lac and SaO2 for prolonged mechanical ventilation time was analyzed by ROC curves.The clinical outcomes in the two groups were recorded.Results There were significant differences in age,preoperative pneumonia,RACHS-1 grading,and levels of ScvO2,Lac and SaO2 among children with different mechanical ventilation time(P<0.05).Multivariate logistic regression analysis showed that ScvO2,Lac and SaO2 were independent influencing factors of postoperative mechanical ventilation time(P<0.05).ROC curves analysis showed that area under the curve(AUC)values of ScvO2,Lac,SaO2 and combined detection for predicting prolonged postoperative mechanical ventilation were 0.846,0.863,0.839 and 0.917,and the best cut-off values were 67.64％,1.51mmol/L and 96.06％,respec-tively(P<0.05).The failure rate of weaning in the prolongation group was higher,and stay time in PICU and actual length of hospital stay were longer than those in non-prolongation group(P<0.05).Conclusion The levels of ScvO2,Lac and SaO2 are related to mechanical ventilation time in CHD infants.They are all independent risk factors affecting prolonged mechanical ventilation and can be applied as auxiliary detection indexes to predict the prolonga-tion of mechanical ventilation in clinical practice.

Objective:Hepatocellular carcinoma(HCC)is the most common primary malignant tumor of the liver.The diagnosis rate of early HCC is low,and most patients are diagnosed at the late stage and have a very poor prognosis.Therefore,it is urgent to explore effective early diagnosis markers and intervention targets for HCC.Cancer/testicular antigen 1A(CTAG1A)is abnormally expressed and highly immunogenic in a variety of tumors,but its expression characteristics and immunogenicity in HCC remain unclear.The aim of this study is to identify the expression and immunogenicity of CTAG1A in HCC tissues and cells,providing a new biomarker for the early diagnosis of HCC and a new potential target for clinical immunotherapy.Methods:This study screened the differentially expressed gene profiles between 10 pairs of very early HCC(BCLC stage 0 HCC)tumors and paracancerous tissues using a transcriptome microarray.The expression of CTAG1A was verified by RT-qPCR in an independent large sample(BCLC stage 0,A,B,C HCC tissues and adjacent non-tumor tissues,n=149)and various hepatocellular carcinoma cell lines.Bioinformatics tools(TepiTool of IEDB database and Swiss Model)were used to predict the MHC-Ⅰ and MHC-Ⅱ epitopes of CTAG1A.The candidate peptides were synthesized by solid-phase polypeptide synthesis method.After purification by HPLC and verification by mass spectrometry assay,the specific T cell responses of peripheral blood mononuclear cells(PBMC)of 9 HCC patients to all peptides were detected by IFN-γ enzyme-linked immunospot assay(ELISpot).The clinical samples were collected from HCC patients admitted to the Third Affiliated Hospital of Naval Medical University(Eastern Hepatobiliary Surgery Hospital)from 2015 to 2022.The collection and usage of all samples were carried out with the consent of the patients,and with the approval of the Ethics Committee of Eastern Hepatobiliary Surgery Hospital(EHBHKY2015-01-017)and in strict accordance with relevant requirements and ethical regulations.Statistical analysis was performed using SPSS 30.0 software,and the diagnostic efficiency was evaluated by ROC curve.Results:Transcriptome chip screening results showed that CTAG1A expression was significantly up-regulated in the very early-stage HCC(BCLC stage 0 HCC)(|FC|=99.16,P<0.0001).The verification using the clinical independent samples showed its high expression in all stages of HCC and better diagnostic efficacy in early-stage HCC(BCLC stage 0 HCC AUC=0.6893,sensitivity=85.71%;BCLC stage A HCC AUC=0.8229,sensitivity=83.33%).Furthermore,the expression of CTAG1A was significantly higher in multiple liver cancer cell lines than in relatively normal liver cell lines(P<0.001).Compared with alpha-fetoprotein(AFP),CTAG1A showed better diagnostic efficacy in BCLC stage 0 and stage A HCC(ROC curve analysis of AFP showed no significant difference in early HCC,P>0.05).Bioinformatics tools predicted that CTAG1A contained 8 MHC-type I and 4 MHC-type II epitopes.The IFN-γ ELISpot assay showed that 12 synthetic peptides could induce PBMC specific T cell response in HCC patients to varying degrees.Conclusion:CTAG1A is significantly overexpressed in early-stage HCC and has multi-epitope immunogenicity,which may activate CD8? and CD4? T cells,suggesting its potential as a target for HCC immunotherapy.It may provide a new direction for developing combined immunotherapy strategies based on mRNA vaccines or adoptive cell therapy.Compared with AFP,CTAG1A exhibits better diagnostic efficacy in early-stage HCC,suggesting its potential as a marker for early diagnosis of HCC.

Objective:To investigate the diagnosis of dual-energy X-ray absorptiometry(DXA)for osteoporosis(OP)of postmenopausal patients with rheumatoid arthritis(RA)in Qinghai region and the risk factors of them.Methods:A total of 200 postmenopausal female RA patients who admitted to Qinghai Hospital of Traditional Chinese Medicine from May 2022 to April 2023 were selected.All patients were tested for bone mineral density(BMD)after admission,and lumbar spines L1-L4,whole lumbar,large trochanter,Ward's triangle area,whole body and whole forearm were measured by DXA.According to the results of BMD test,patients whose BMD T values of all body parts-2.5 SD were less or equal to-2.5 were included in the OP group(121 cases),and patients whose BMD T value of all body parts were larger than-2.5 SD were included in the non-OP group(79 cases).The BMD T value of different body parts between two groups of RA patients were compared and analyzed.The area under curve(AUC)of receiver operating characteristic(ROC)curve was used to analyze the diagnostic efficiency of BMD T value for OP.The logistic regression method was adopted to analyze the risk factors that postmenopausal RA patients of Qinghai region occurred OP.Results:The BMD T values of L1,L2,L3,L4,whole lumbar,large trochanter,Ward's triangular area,whole body and whole forearm of OP group were obviously lower than those of the non-OP group.In analysis of ROC curve,the sensitivities of BMD T values of L1,L2,L3,L4,whole lumbar,large trochanter,Ward's triangle area,whole body and forearm were respectively 96.20%,95.22%,90.16%,96.03%,92.01%,89.36%,99.26%,90.02% and 96.03% in diagnosing OP,and the specificities of them were respectively 81.00%,82.19%,85.22%,83.06%,83.06%,90.22%,80.06%,86.23%,83.09%,and the AUC values of them were respectively 0.908,0.905,0.896,0.906,0.903,0.879,0.918,0.901 and 0.906.The results of the logistic-regression analysis showed that advanced age,long disease course,rheumatic activity scores of 28 joints,erythrocyte sedimentation rate and Calcium supplementation were the risk factors of occurring OP in postmenopausal RA patients in Qinghai region.Conclusion:The DXA method that detects BMD of RA patients who occur OP can be used as gold standard to assess OP,and there are many risk factors that affect the occurrence of OP in postmenopausal RA patients of Qinghai region.The clinical work should combine with relative factors to formulate reasonable measure so as to reduce the incidence of OP.

Objective:To study the influence of the severity of diabetic retinopathy (DR) on the visual function of patients with type 2 diabetes, to provide scientific basis for the early prevention and control of DR.Methods:This study was designed as a cross-sectional study, recruiting already-diagnosed type 2 diabetes patients in four community health service centers in Guizhou Province between February and September 2022. Employing the Chinese version of the Visual Function Index-14 (VF-14), assess the participants′ near vision, visual adaptation, subjective visual perception, and stereo vision, with higher scores indicating poorer visual function. Categorize the severity of each eye′s damage into no diabetic retinopathy (DR), mild non-proliferative diabetic retinopathy (NPDR), moderate NPDR, severe NPDR, and proliferative diabetic retinopathy (PDR), and use a 5-level DR grading system to evaluate the overall severity of diabetic retinopathy in both eyes. Employing linear regression analysis to investigate the linear relationship between DR and visual function index. Local weighted regression evaluates the nonlinear relationship between the DR composite score and the scores of visual function, with a steeper slope indicating poorer visual function for that level.Results:A total of 542 patients with type 2 diabetes were investigated, including 244 (45.02%) males, 298 (54.98%) females, and 162 (29.89%) patients with DR. After adjusting for confounders, compared with those without DR, patients with binocular DR Had overall scores ( β=0.136, P=0.003), near vision ( β=0.163, P<0.001), visual adaptation ( β=0.092, P=0.042), subjective vision ( β=0.120, P=0.009) and stereo vision ( β=0.094, P=0.044) were higher than those without DR. There were no differences in visual functions between DR And monocular DR. The local weighted regression curve showed that near vision (slope: 23.78) and overall score (slope: 58.37) increased sharply from mild to moderate NPDR in both eyes. Visual adaptation (slope: 5.37, 7.72), subjective vision (slope: 6.53, 7.93), stereovision (slope: 0.74, 0.91) increased slowly in mild to moderate NPDR in both eyes and in moderate to severe NPDR/PDR in both eyes. Conclusion:Binocular DR is associated with impaired visual function, but there is no difference between monocular DR And non-DR visual function. The early damage of DR To visual function is mainly manifested in near vision. In the prevention and control of DR, more attention should be paid to visual function, especially the change of near vision, and retinal damage should not be assessed solely by visual status.

OBJECTIVE To investigate the preventive effect of cucurbitacin B （CB） on sepsis-induced acute lung injury （ALI） and its mechanism. METHODS The mice were divided into control group， model group， dexamethasone group （positive control， 2 mg/kg）， CB low-dose and high-dose groups （25， 50 mg/kg）. Each group was given relevant medicine intraperitoneally， once a day， for 3 consecutive days. Twenty-four hours after the last administration， those groups were given lipopolysaccharide （10 mg/kg） intraperitoneally to establish sepsis-induced ALI model （finally， 8 mice per group were included in the experiment）， except for control group. Twenty-four hours after medication， blood routine indicators （total white blood cell count， neutrophils count， lymphocytes count）， lung function indicators （total lung resistance， pulmonary outflow resistance， lung dynamic compliance， peak expiratory flow rate， and maximum ventilation volume）， dry wet ratio of lung tissue were measured in each group. The lung tissue level of myeloperoxidase （MPO）， and the serum levels of tumor necrosis factor-α （TNF-α）， interleukin 1β （IL-1β）， IL-6， superoxide dismutase （SOD） and malondialdehyde （MDA） were all detected. The pathological changes of lung tissue were observed； immunohistochemistry was used to detect the positive expression of phosphorylation signal transducer and activator of transcription 3 （p-STAT3） in the lung tissue. Western blot assay was used to detect the expressions of proteins related to IL-6/JAK2/ STAT3 signaling pathway in the lung tissue. RESULTS Compared with control group， total pulmonary resistance， pulmonary flow resistance， dry wet ratio of lung tissue， the total white blood cell count， neutrophils count， lymphocytes count of whole blood， the lung tissue level of MPO and serum levels of MDA， IL-6， IL-1β and TNF-α， the p-STAT3 protein optical density value， the protein expressions of IL-6 and IL-6 receptor， and the phosphorylation levels of JAK2 and STAT3 protein were increased significantly in the model group （P＜0.01）， while lung dynamic compliance， peak expiratory flow rate， maximum ventilation volume and serum level of SOD were decreased significantly （P＜0.05 or P＜0.01）. Pulmonary tissue showed alveolar collapse and infiltration of inflammatory cells. Compared with the model group， the above indexes of mice were reversed significantly in dexamethasone group and CB groups （P＜0.05 or P＜0.01）， the pathological damage of lung tissue was reduced. CONCLUSIONS CB can prevent sepsis-induced ALI by inhibiting the activity of Δ 基金项目遵义市科技计划项目（No.202252） IL-6/JAK2/STAT3 signaling pathway and relieving ＊第一作者主治医师。研究方向：重症医学。E-mail：fjuanxui@ 163.com inflammatory reactions. # 通信作者 主任医师。研究方向：儿童呼吸系统疾病诊断与治

Objective:To study the influence of the severity of diabetic retinopathy (DR) on the visual function of patients with type 2 diabetes, to provide scientific basis for the early prevention and control of DR.Methods:This study was designed as a cross-sectional study, recruiting already-diagnosed type 2 diabetes patients in four community health service centers in Guizhou Province between February and September 2022. Employing the Chinese version of the Visual Function Index-14 (VF-14), assess the participants′ near vision, visual adaptation, subjective visual perception, and stereo vision, with higher scores indicating poorer visual function. Categorize the severity of each eye′s damage into no diabetic retinopathy (DR), mild non-proliferative diabetic retinopathy (NPDR), moderate NPDR, severe NPDR, and proliferative diabetic retinopathy (PDR), and use a 5-level DR grading system to evaluate the overall severity of diabetic retinopathy in both eyes. Employing linear regression analysis to investigate the linear relationship between DR and visual function index. Local weighted regression evaluates the nonlinear relationship between the DR composite score and the scores of visual function, with a steeper slope indicating poorer visual function for that level.Results:A total of 542 patients with type 2 diabetes were investigated, including 244 (45.02%) males, 298 (54.98%) females, and 162 (29.89%) patients with DR. After adjusting for confounders, compared with those without DR, patients with binocular DR Had overall scores ( β=0.136, P=0.003), near vision ( β=0.163, P<0.001), visual adaptation ( β=0.092, P=0.042), subjective vision ( β=0.120, P=0.009) and stereo vision ( β=0.094, P=0.044) were higher than those without DR. There were no differences in visual functions between DR And monocular DR. The local weighted regression curve showed that near vision (slope: 23.78) and overall score (slope: 58.37) increased sharply from mild to moderate NPDR in both eyes. Visual adaptation (slope: 5.37, 7.72), subjective vision (slope: 6.53, 7.93), stereovision (slope: 0.74, 0.91) increased slowly in mild to moderate NPDR in both eyes and in moderate to severe NPDR/PDR in both eyes. Conclusion:Binocular DR is associated with impaired visual function, but there is no difference between monocular DR And non-DR visual function. The early damage of DR To visual function is mainly manifested in near vision. In the prevention and control of DR, more attention should be paid to visual function, especially the change of near vision, and retinal damage should not be assessed solely by visual status.

Objective:To study the clinical value of serum adenosine deaminase (ADA) combined with whole blood microRNA (miR)-197-3p in the diagnosis of human brucellosis.Methods:From January 2020 to September 2023, 120 patients with brucellosis were selected from the Department of Pulmonary and Critical Care Medicine, Affiliated Hospital of Jining Medical University (referred to as this hospital) and assigned to the brucellosis group, including 89 patients in the acute stage, 19 patients in the chronic stage, and 12 patients in the latent infection. In addition, 60 healthy volunteers from the animal husbandry industry were selected as the control group from the physical examination population in this hospital during the same period; sixty critically ill patients with community-acquired pneumonia were selected from the Department of Pulmonary and Critical Care Medicine of this hospital as the infection control group. Patients in the brucellosis group and infection control group were given standardized treatment. Fasting elbow venous blood samples were collected in the morning before and after treatment in the brucellosis group and infection control group, at enrollment in the control group, and serum ADA and whole blood miR-197-3p levels were tested. Multivariate logistic regression analysis was used to study the risk factors affecting the occurrence of brucellosis. Receiver operating characteristic (ROC) curve was used to evaluate the diagnostic efficacy of ADA, miR-197-3p, and their combination for brucellosis.Results:Before treatment, the levels of serum ADA (U/L: 12.35 ± 2.89, 18.33 ± 4.57, 29.75 ± 6.46, 22.20 ± 4.78, 14.15 ± 3.03) and whole blood miR-197-3p (1.09 ± 0.33, 2.25 ± 0.41, 2.68 ± 0.59, 2.43 ± 0.51, 1.18 ± 0.40) in the control, infection control, acute stage, chronic stage, and latent infection groups were compared, and the differences were statistically significant ( F = 4.38, 4.02, P = 0.014, 0.019). Compared with the control group, the serum ADA and whole blood miR-197-3p levels in the other 4 groups were higher ( P < 0.05). Compared with the infection control group, the serum ADA level in the acute stage and chronic stage groups was higher, and the serum ADA level in the latent infection group was lower ( P < 0.05); the level of whole blood miR-197-3p was higher in the acute stage group, but lower in the latent infection group ( P < 0.05). Compared with before treatment, the levels of serum ADA and whole blood miR-197-3p in the infection control, acute stage and chronic stage groups were lower after treatment ( P < 0.05). Multivariate logistic regression analysis showed that increased levels of serum ADA and whole blood miR-197-3p were risk factors for brucellosis [odds ratio ( OR) = 2.235, 3.404, 95% confidence intervals ( CI): 1.491 - 3.362, 1.623 - 7.605, P < 0.001]. ROC curve results showed that serum ADA and whole blood miR-197-3p had auxiliary significance in the diagnosis of brucellosis ( P < 0.001). The area under curve (AUC) of serum ADA combined with whole blood miR-197-3p was 0.933, which was superior to the diagnostic efficacy of serum ADA and whole blood miR-197-3p alone (AUC = 0.823, 0.840). Conclusion:The combination of serum ADA and whole blood miR-197-3p has high clinical value in the diagnosis of human brucellosis, and can provide an important reference for the clinical diagnosis and efficacy evaluation of brucellosis.